Fluoride Toothpaste for Kids: How Much, Which Kind, and When

By Dr. Mohsen Alozaibi, Tiny Teeth Dental Center, Abu Dhabi

"Is fluoride safe for my baby? What if she swallows it?" Parents ask me this almost every week. The short answer: used in the right amount, fluoride toothpaste is one of the simplest and best-proven ways to protect your child's teeth from cavities.

What fluoride does

Fluoride is a natural mineral that strengthens tooth enamel and helps repair the very early stages of decay, before a hole forms. Brushing with fluoride toothpaste twice a day puts a little fluoride on the teeth each time, and that small, regular contact is what makes the difference.

How much to use

The amount matters more than most parents think:

• From the first tooth until age 3: a smear the size of a grain of rice. Just enough to lightly coat the bristles.
• From age 3 to 6: a pea-sized amount.
• Older children: a pea-sized amount is usually still enough. Children don't need the long stripe of paste you see in advertisements.

A simple tip: squeeze the toothpaste across the bristles rather than along them, and put the paste on yourself until your child can reliably measure it.

Spit, don't rinse

After brushing, encourage your child to spit out the extra toothpaste but not rinse with water. Rinsing washes the fluoride away. A little foam left in the mouth is fine and keeps working on the teeth.

Babies and young toddlers can't spit yet, and that's okay. Wipe away any extra foam with a clean cloth if you like. Learning to spit usually comes around age 3, so make a game of it.

"What if my child swallows it?"

Young children will swallow some toothpaste, and at a rice-grain or pea-sized amount, that is safe. This is exactly why the recommended amounts are so small.

Problems come from much larger amounts. Regularly swallowing a lot of toothpaste while the adult teeth are forming (roughly up to age 6 to 8) can cause faint white marks or streaks on the adult teeth, called fluorosis. Eating a large amount at once, such as a tube, can upset the stomach; if that happens, contact a doctor or poison information service straight away.

Choosing a toothpaste

Turn the tube over and look at the fluoride content, usually written in ppm (parts per million):

• For most children, a toothpaste with about 1,000 to 1,450 ppm fluoride gives good protection.
• Some "kids" or "training" toothpastes contain little or no fluoride. They may taste nice, but they offer much less protection against cavities.
• Flavour, colour and cartoon characters don't affect how well a toothpaste works. Pick a fluoride level first, then a flavour your child accepts. A mild flavour often helps children who dislike strong mint.

If your child has a high risk of cavities, or you're unsure which toothpaste fits, ask your dentist. They may also suggest fluoride varnish applied at check-ups.

Safety at home

• Supervise brushing so the paste goes on the brush, not straight into your child's mouth.
• Store toothpaste out of reach, as you would medicines. Bright packaging and sweet flavours can make it look like a treat.
• Mouthwash is usually not recommended for children under 6, as they tend to swallow it. Ask your dentist before starting one.